RU2379051C1 - Method for immunologic estimation of conservative treatment of osteoarthrosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly orthopaedics and traumatology, namely the methods for controlling the therapeutic treatment of the patients suffering from great arthropathy. The specified effect is ensured by determining the serum cytokine level IL-1β, TNFα by the EIA method with applying diagnostic test systems before treatment, 6, 12 and 18-24 months later. If IL-1β concentration is decreased within 6-24 months, and TNFα concentration - within terms 12-24 months, conservative treatment is estimated as satisfactory. If IL-1β recovers its initial concentration within 12, 18-24, while TNFa - within 18-24, the conservative treatment is considered to be unsatisfactory.

EFFECT: estimation of stability of therapeutic treatment of great osteoarthrosis 1^st stage.

4 dwg, 2 ex

Description

The invention relates to medicine, in particular to orthopedics and traumatology, and in particular to methods of monitoring the therapeutic treatment of patients suffering from diseases of large joints.

There is a method of evaluating the effectiveness of conservative treatment of congenital clubfoot, in which anthropometric studies are carried out by measuring the circumference of the lower leg at the level of the ankle joint and subsequent conversion of the obtained values into arc degrees (Patent No. 2267988 of the Russian Federation. Publish. 2006.01.20).

An invention is known in which autologous blood is irradiated with X-rays and is subsequently administered into a patient’s body with subsequent evaluation of the effectiveness of this treatment according to clinical and immunological parameters, in addition, the patient’s age is determined, erythrocyte sedimentation rate is used as clinical indicators, and HLA is identified as immunological indicator. -phenotype of the patient, after which the estimated indicator is calculated using the mathematical expression (Patent No. 2052201, RF. Publ. 1996.01.10).

However, the known method is not intended to assess the persistence of therapeutic treatment of osteoarthrosis of large joints of the I-II stage.

A known method, the essence of which is the assessment of the results of treatment of polycystic kidney disease by determining the immunological parameters in a patient before and after treatment (Application No. 92003079, RF. Publ. 1997.01.27).

However, the known method is not intended to assess the persistence of therapeutic treatment of osteoarthrosis of large joints of the I-II stage.

The objective of the present invention is to assess the persistence of therapeutic treatment of osteoarthrosis of large joints of the I-II stage.

The problem is solved in that in the method of immunological evaluation of the effectiveness of conservative treatment of osteoarthritis, the concentration of serum cytokines (IL-1β, TNFα) is determined before treatment, after 6, 12 and 18-24 months and with a decrease in the concentration of IL-1β in the period of 6-24 months and TNFα in the period of 12-24 months evaluate the result of conservative treatment as satisfactory, when IL-1β returns in the period of 12, 18-24 months to the initial concentrations, and TNFα in the period of 18-24 months evaluate the result of conservative treatment as unsatisfactory.

The present invention is illustrated by a detailed description, clinical examples and diagrams in which:

Figure 1 characterizes the content of IL-1β. Moreover, 1 - control group, 2 - before treatment, 3 - 6 months after the start of conservative therapy, 4 - 12 months after the start of conservative therapy, 5 - 18-24 months after the start of conservative therapy; * - p <0.05 relative to the initial values;

Figure 2 characterizes the content of TNFα. Moreover, 1 - control group, 2 - before treatment, 3 - 6 months after the start of conservative therapy, 4 - 12 months after the start of conservative therapy, 5 - 18-24 months after the start of conservative therapy; * - p <0.05 relative to the initial values;

Figure 3 characterizes the content of IL-1β and TNFα in the peripheral blood of patient D., 38 years old (medical record No. 8964. Diagnosis: bilateral osteoarthritis of the knee joint, II stage). Moreover, 1 - control group, 2 - before treatment, 3 - 6 months after the start of conservative therapy, 4 - 12 months after the start of conservative therapy, 5 - 18-24 months after the start of conservative therapy;

Figure 4 characterizes the content of IL-1β and TNFα in the peripheral blood of the patient U., 33 years old (medical record No. 8217. Diagnosis: bilateral osteoarthritis of the knee joint, Art. I). Moreover, 1 - control group, 2 - before treatment, 3 - 6 months after the start of conservative therapy, 4 - 12 months after the start of conservative therapy, 5 - 18-24 months after the start of conservative therapy.

The method of immunological evaluation of the effectiveness of conservative treatment of osteoarthritis is as follows.

Drug therapy includes the appointment of chondroprotectors with the ability to inhibit proteolytic enzymes, stimulate the synthesis of proteoglycans by chondrocytes and hyaluronic acid by synoviocytes, and improve the rheological properties of synovial fluid.

The patient is injected intramuscularly with chondrolone or alflutop 1 ml each (No. 15), then teraflex 2 capsules 3 times a day for 3 weeks, and subsequently 1 capsule 2 times a day for 2 months. The range of therapeutic measures also includes non-steroidal anti-inflammatory drugs (NSAIDs), the analgesic and anti-inflammatory effects of which are due to the inhibition of cyclooxygenase (COX) activity, a key enzyme of arachidonic acid metabolism. Nimulide is prescribed 1 tablet 2 times a day for 14 days, diclofenac - 1 tablet (25 mg) 3 times a day for 7 days. To prevent complications from the gastrointestinal tract, all patients are prescribed Omez 1 capsule before breakfast while taking NSAIDs. The course of conservative treatment lasts an average of 3 months.

In addition, patients are prescribed a complex of physiotherapy exercises, which helps to reduce arthralgia and improve the functions of the affected joints. Also, patients undergo physiotherapeutic procedures (electrophoresis, ultrasound, laser, magnet), which help relieve pain, reduce swelling of the periarticular tissues, reflex spasm of the periarticular muscles, and improve microcirculation.

Determination of the concentration of serum cytokines (IL-1β, TNFα) is carried out by ELISA using diagnostic test systems of LLC Cytokine (St. Petersburg). As control immunological indicators of 29 volunteers of a similar age using no clinical signs of osteoarthritis are used. Relative contraindications for the use of this method are chronic somatic diseases in the acute stage, acute respiratory viral infections, HIV infection. An immunological examination is carried out before treatment, after 6, 12, 18-24 months after the start of complex, pathogenetically substantiated, conservative therapy.

In patients with both satisfactory results of conservative treatment (a significant decrease in the intensity of pain in the affected joint, a stable therapeutic effect for at least 24 months), and with unsatisfactory results of the treatment (preservation of pain), a decrease in serum levels is observed 6 months after the start of conservative therapy IL-1β. Moreover, in patients with satisfactory treatment results, these changes persist throughout the observation period, and in the group with no therapeutic effect - no more than 6 months (Figure 1). The content of initially elevated TNFα in both groups decreases 12 months after the start of conservative therapy. However, in the group with unsatisfactory treatment results, after 18-24 months after the start of treatment, this indicator rises, returning to the initial values, and in the group with satisfactory results, TNFα remains at the level of the values of the control group (Figure 2).

Examples of clinical use of the method.

Example 1

Patient D., 38 years old. Medical card number 8964. Diagnosis: bilateral osteoarthrosis of the knee joint II tbsp. I went to the clinic of the Center with complaints of diffuse, intermittent pain in the joint that occurs during or immediately after physical exertion, short night pains, moderate pain in the periarticular tissues. The diagnosis is based on the results of R-graphy and ultrasound. Sick for 5 years. The place of residence was not treated. Appointed a comprehensive conservative treatment: Alflutop 1 ml (No. 15) intramuscularly, then Teraflex 2 capsules 3 times a day for 3 weeks, followed by 1 capsule 2 times a day for 2 months, exercise therapy, physiotherapy, massage. 3 months after the start of therapy, the pain was stopped. The achieved therapeutic effect lasted for 24 months. In relation to the studied cytokines, the following dynamics was observed: the concentration of serum IL-1β decreased after 6 months, the concentration of fold TNFα decreased 12 months after the start of the course of treatment. The result of the treatment is regarded as satisfactory. Both indicators reached the values of the control group and remained at this level during the subsequent stages of observation (12-24 months).

Example 2

Patient U., 33 years old. Medical card number 8217. Diagnosis: bilateral osteoarthrosis of the knee joint, Art. I went to the clinic of the Center with complaints of diffuse joint pain that occurs during or immediately after physical exertion, short night pains, crepitus in the joints with maximum flexion (180 °) and extension (30 °). The diagnosis is based on the results of R-graphy and ultrasound. Sick for 6 years. She was not treated medically at the place of residence, periodically underwent a massage course. The patient was prescribed a comprehensive conservative treatment: Alflutop 1 ml (No. 15) intramuscularly, then Teraflex 2 capsules 3 times a day for 3 weeks, then 1 capsule 2 times a day for 2 months, exercise therapy, physiotherapy. Pain syndrome, “crepitus” in the joints with maximum flexion and extension after conservative therapy were maintained. The result of treatment is regarded as unsatisfactory. The concentration of serum IL-1β decreased after 6 months, returning to baseline values 12 months after the start of treatment. The concentration of serum TNFα decreased 12 months after the start of the course of treatment and returned to its initial values 24 months after the start of therapy.

The proposed method allows to evaluate the durability of the therapeutic treatment of osteoarthrosis of large joints of the I-II stage.

The proposed method is used in the clinic and laboratory of microbiology and immunology of FGU RSC "WTO" them. Academician G.A. Ilizarov.

Claims (1)

A method for immunological evaluation of the effectiveness of conservative treatment of osteoarthritis, characterized in that the concentration of serum cytokines (IL-1β, TNFα) is determined before treatment after 6, 12 and 18-24 months and with a decrease in the concentration of IL-1β in the period of 6-24 months and TNFα periods of 12-24 months evaluate conservative treatment as satisfactory, when IL-1β returns to periods of 12, 18-24 months to the initial concentrations, and TNFα - within 18-24 months, conservative treatment is assessed as unsatisfactory.

Images